One month into the pandemic, Manitoba appeared to hammer the COVID-19 curve down to the flattest of pancakes through a combination of decisive public policy, collective adherence to public health orders and a little bit of blind luck.
With the benefit of hindsight, it appears luck may have played a far greater role in that achievement.
Since the middle of September, Manitoba has reported as many new cases of COVID-19 as it did during the previous six months. The death toll due to the disease in Manitoba has also doubled since the middle of September.
Much of this is due to widespread community transmission in Winnipeg, now the overwhelming epicentre of the pandemic in this province. Part of this is due to poor adherence to public health orders.
And if you ask provincial opposition leaders, some of this is due to poor public policy.
What became clear on Tuesday is public health officials are running out of tools to hammer the COVID-19 curve, which currently resembles the western slope of the Rocky Mountains, back into something better resembling the flat expanse of the Red River Valley.
“Because we’re seeing that community based transmission in Winnipeg, it’s really tough to have any more targeted interventions. We’ve sort of went that way already,” Chief Provincial Public Health Officer Dr. Brent Roussin said on Tuesday, when Manitoba announced a record daily number of new COVID-19 cases and a record-high test-positivity rate.
A sledgehammer, vs. a scalpel
What Roussin means by “targeted interventions” is new restrictions aimed at specific sources of the spread.
The earlier closing time for Winnipeg-area bars and licensed restaurants, which went into effect one week ago, is an example of a targeted intervention. It was intended to combat the spread of the virus later in the evening, when intoxicated adults may be more inclined to let their guards down when it comes to keeping their distance from each other.
Manitoba’s top doctor made it clear the next tool in his pandemic arsenal will be a sledgehammer instead of a scalpel. He could, for instance, order all Winnipeg restaurants and bars closed.
That move would threaten many independent businesses that have yet to recover from the initial, shutdown phase of the pandemic in April.
Roussin could also order a broader shutdown of all restaurants, bars, gyms, movie theatres, casinos and performing-arts venues, the way Ontario did with Toronto, Ottawa and the Peel region on Friday, after Canada’s largest province reported fewer new cases per capita than Manitoba did on Tuesday.
Roussin, for the record, is not overly fond of lockdowns.
“We know that a lockdown — shutting businesses or limiting businesses — have huge impacts on individuals and it has huge impacts on individuals health,” he said during Tuesday’s press briefing.
“We know we can’t let this virus just simply transmit in our communities because we know what will happen if we have overwhelming numbers and overwhelm our health-care system.”
“But we can’t simply lock down things every time because, really, it’s not going to be a two-week lockdown. After two weeks, we’ll be right back to where we were, if we go back to the same activities.”
In other words, the key to getting the Winnipeg outbreak under control is getting Winnipegers to change their behaviour and actually choose to stay the heck away from each other as much as possible before they’re ordered to do so.
“Winnipeggers need to be taking precautions,” Health Minister Cameron Friesen said on Tuesday. “I think that people have been lulled into a false sense of security following weeks and weeks of low numbers — and now we are seeing that that response is insufficient.”
That statement earned a strong rebuke from Manitoba’s Liberal leader.
“This government is telling people, keep these businesses open, keep these bars open, keep these restaurants open, business as usual. But then at the same time, they want to blame people for going to the bar,” Dougald Lamont said.
New lockdown not inevitable
A limited lockdown may not be inevitable. But Roussin made it clear more restrictions are coming if Winnipeggers do not get their collective acts together.
The pandemic response system he helped devise also suggest Winnipeg is already close to the conditions that could trigger an upgrade to a red, or critical designation.
There are three general conditions to going red. One is extensive and uncontained community transmission. Another is widespread outbreaks and clusters that can not be contained through COVID-19 testing and contact tracing.The third is transmission “at levels that public health and the health system deem concerning or critical.”
Right now, it’s clear the health-care system can handle the number of COVID-19 patients in Winnipeg hospitals.
The community transmission and outbreak metrics, however, are approaching critical.
COVID-19 has spread into Winnipeg-area jails and personal care homes. The test-positivity rate for Winnipeg alone is 4.5 per cent, which is well beyond the comfort zone. There are lengthy waits to get a COVID-19 swab. Public health staff are so busy, they can take as long as a week to notify patients of a positive test result. They’re also too busy to follow up with older cases and designate patients as recovered.
Health-care indicators a saving grace
Of the 13 separate monitoring indicators that determine a designation in the pandemic response system, no fewer than six are already red flags.
The saving grace right now are the health-care indicators — hospital capacity, intensive-care capacity and the supply of protective equipment — are all looking good at the moment.
“One of the biggest goals of a pandemic response is to minimize severe outcomes and the burden on the health care system,” Roussin said Tuesday. “Right now, we’re not seeing that strain on our health-care system.”
The caveat is health-care indicators tend to lag behind new cases. A sharp rise in Winnipeg-area hospitalizations over the next few weeks may give Roussin no choice but to order a new lockdown.
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